| NPI | 1649513045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD471485) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME 130033) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME130033) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-09-02 |