| NPI | 1235712324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 67371) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ 67371) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2022-11-02 |