| NPI | 1780112672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MN 73613) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-02387) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0006457) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2023-09-04 |