| NPI | 1053609149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101253044) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA (0101253044) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101253044) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2022-07-21 |