| NPI | 1902060551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: PA MT182000) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD427228) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME163667) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT182000) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2024-04-12 |