| NPI | 1700318607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: IA MD-49555) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: IA MD-49555) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10063894) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2025-05-20 |