| NPI | 1982021911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CA A168254) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4270) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2022-12-17 |