| NPI | 1033561816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A179330) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A179330) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-08-05 |