| NPI | 1477971455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 55479) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 55479) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63396) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 63396) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2022-04-21 |