NPI | 1114307287 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101272862) |
Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101272862) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209550) | |
Enumeration Date | 2015-06-04 |
Last Update Date | 2022-02-04 |