| NPI | 1043675028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: LA 345108) |
| Additional Taxonomies | 2085N0700X (Licence: LA 345108) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2026-02-18 |