| NPI | 1598085425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: UT 9761214-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA FF2676433) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2021-10-27 |