| NPI | 1235517558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME150046) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 1235517558) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN21771) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2024-05-29 |