| NPI | 1063845709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OK 39577) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2022-06-25 |