| NPI | 1265875314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD466990) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MT204522) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2019-12-23 |