| NPI | 1194922120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 67664) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 67664) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 135300) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-03-14 |