| NPI | 1013118207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2011-01451) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 141684) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 201101451) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2016-09-14 |