| NPI | 1053790352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 65916) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 302943) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65916) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 302943) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2024-06-25 |