| NPI | 1568758878 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 27792) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-39693) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 27792) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 57947) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 57947) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2024-03-31 |