| NPI | 1598386369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL 39) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 39) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 39) | |
| Enumeration Date | 2020-05-02 |
| Last Update Date | 2021-07-20 |