| NPI | 1114487873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2024-00370) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-03-04 |