| NPI | 1598028086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301100402) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN24627) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL TRN24627) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-01-07 |