| NPI | 1255743605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: ME DO3056) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS15702) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL OS15702) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2020-07-07 |