| NPI | 1275038671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS21949) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL OS21949) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO6110) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2025-05-15 |