| NPI | 1558584086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 72264) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 72264) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN Radiology) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2023-03-07 |