| NPI | 1245467232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WV 30182) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 16209) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30182) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2022-04-15 |