| NPI | 1083063135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0066025) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: CO DR.0066025) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0066025) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0006280) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2021-09-21 |