| NPI | 1134383417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 52237) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 104523) |
| 2085R0001X Radiology, Radiation Oncology (Licence: WI 55771-020) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2020-08-14 |