| NPI | 1144554577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX P9875) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP20038032) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2015-07-23 |