| NPI | 1487213484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 85100-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036163712) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 28488) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.075325) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2025-09-10 |