NPI | 1720340490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 294220) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT202269) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 193460) | |
Enumeration Date | 2012-06-08 |
Last Update Date | 2018-07-28 |