| NPI | 1447661053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: UT 11260648-1204) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 11260648-1204) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2019-07-16 |