| NPI | 1912268780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 281812) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD16378) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: RI MD16378) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2021-06-10 |