| NPI | 1033371430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 242479) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA mt193804) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 242479) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2014-02-15 |