| NPI | 1164602926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: FL ME128898) |
| Additional Taxonomies | 2085N0700X (Licence: MO 2011015524) |
| 2085N0700X (Licence: TX N4199) | |
| 2085N0700X (Licence: NM MD2022-1392) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO FW1856371) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME128898) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2023-06-29 |