| NPI | 1639382302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60149277) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60149277) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301088522) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-04-25 |