| NPI | 1184699688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: AZ 16775) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 16775) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2015-01-14 |