| NPI | 1962817676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MI 4301502631) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116028364) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0116028364) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301502631) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-11-27 |