| NPI | 1083971683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.140910) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: GA 77947) |
| 2085R0001X Radiology, Radiation Oncology (Licence: KY R2872) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2023-02-14 |