| NPI | 1033504691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NY 325747) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MA 287001) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63661) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2024-05-09 |