| NPI | 1750814877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A208707) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD469047) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2026-06-03 |