| NPI | 1023225406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 278529) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD 60056527) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-08-12 |