He was unable to afford a medical license because he sent all his money home to provide for his family. He was working as a pathologist when Finch paid him to save Reese's life after being shot by Tyrell Evans. (“Number Crunch”) When Shaw got wounded while protecting a young person of interest from being killed by HR, Finch asked her to let Dr. Madani help her because he would still owe Finch a favor. (“Razgovor”)
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