| NPI | 1699064196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 202302765) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-53573) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-255) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME131503) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2025-03-13 |