| NPI | 1912252404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: FL ME152815) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 70246) |
| 2085B0100X Radiology Body Imaging (Licence: GA 70246) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 39782) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 5673) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2023-12-06 |