| NPI | 1851822233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 0068127) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 73519) |
| 2085N0904X (Licence: CO 0068127) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 0068127) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-10-30 |