| NPI | 1720546203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NH R3880) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2022-07-13 |