| NPI | 1689043291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA A171850) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IL 125.067931) | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2022-10-12 |