| NPI | 1710398474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KY 55269) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036143613) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 036143613) | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2022-07-21 |