| NPI | 1447666219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 70688-20) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 53590) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 584897) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-06-08 |