| NPI | 1528440690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 75569-20) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 036151947) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10053652) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036.151947) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2021-07-29 |