| NPI | 1023507258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: OH 35.147837) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH APP-000144409) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-10-09 |