| NPI | 1578095139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 66344) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 1014533) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2023-05-13 |