| NPI | 1104212091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2021-01385) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 2021-01385) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: WI 73041-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2025-07-03 |