| NPI | 1194068841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: DE C1-0012765) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD464808) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2019-07-29 |