| NPI | 1821479593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: SC 85556) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: IA R-10411) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-07-23 |