| NPI | 1417537051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MO 2023012492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022022102) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2023-10-02 |