| NPI | 1821382409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX T3215) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA OS018849) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2022-02-22 |