| NPI | 1225353550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM MD2016-0170) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME121091) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2016-07-26 |