| NPI | 1255776126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: OH 35.149257) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MN 67074) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2023-10-09 |