| NPI | 1609200633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 90876) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 90876) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2023-03-01 |