| NPI | 1265816631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 66403) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A144471) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A144471) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2022-09-09 |