| 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 |