| NPI | 1114131588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 51225) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018302) |
| 2085N0700X Radiology, Neuroradiology (Licence: SC 33948) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2014-09-24 |