| NPI | 1831533231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A133457) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 18934) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2025-06-26 |