| NPI | 1861854945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CT 69799) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD18229) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-01-02 |