| NPI | 1346660958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME145056) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.025220) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2023-11-28 |