| NPI | 1205497815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 20353) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-03260) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2020-03260) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 256282) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2025-08-18 |