| NPI | 1679701791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TN 55556) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: VA 0101250533) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101250533) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116021819) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2021-04-09 |