| NPI | 1871914457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60844923) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: WA MD60844923) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A132735) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-12-26 |
| Last Update Date | 2024-08-30 |