| NPI | 1902169527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX R6401) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME131709) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301101232) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2022-07-21 |