| 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 |