| NPI | 1306021704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NC 2012-00139) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 162768) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-00139) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2023-03-10 |