| NPI | 1447785480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX R8126) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 87308) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2022-0182) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57173) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2024-04-11 |