| NPI | 1033508353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME156842) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A158271) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 053893563) | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2022-05-25 |