NPI | 1538553052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A146711) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IL 125.075401) | |
Enumeration Date | 2015-03-23 |
Last Update Date | 2021-07-29 |