| 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 |