| NPI | 1811429939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME161933) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T7519) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2023-06-27 |