| NPI | 1285139345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2023016073) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-11417) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-06-24 |