| NPI | 1508220153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 93191) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: MI 4301502541) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2024-09-06 |