| NPI | 1538696778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A190232) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 33110) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OK 33110) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME161812) | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2024-05-20 |