| NPI | 1992071385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: VA 0101264657) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM 61570-20) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2018-07-20 |