| 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 |