| NPI | 1396190245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A151728) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 287098) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A151728) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 287098) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2022-06-15 |