| NPI | 1669761862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA a143217) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A143217) |
| 208D00000X General Practice (Licence: NY 275244) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2021-09-23 |