| NPI | 1457644890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME132109) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57555) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME132109) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 57555) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2023-11-17 |