| NPI | 1912536640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 77763) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 77763) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2024-12-04 |