| NPI | 1982929840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OR MD206229) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: OH 35.128808) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2021-09-07 |