| NPI | 1073762779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301098829) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301098829) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2021-06-08 |