| NPI | 1043472152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NY 265434) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 150392) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2015-06-22 |