| NPI | 1710229968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA 466225) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD466225) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NJ 25MA10552400) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2020-10-12 |