| NPI | 1396970323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: SC 81911) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101252849) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2019-04-17 |