| NPI | 1477998250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: AZ R75048) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0068236) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2022-06-30 |