NPI | 1962834671 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME135034) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT203710) |
2085R0202X Radiology, Diagnostic Radiology (Licence: WI 22865) | |
390200000X Student in an Organized Health Care Education/Training Program | |
207R00000X Internal Medicine (Licence: PA MT203710) | |
Enumeration Date | 2013-08-05 |
Last Update Date | 2024-01-10 |