NPI | 1164841888 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 83593) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-04-09 |
Last Update Date | 2019-11-05 |