| NPI | 1073990644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AL MD.48566) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME144525) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME144525) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-02 |
| Last Update Date | 2024-04-09 |