| NPI | 1962558577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0435699) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: GA 004991) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2250) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-03-15 |