| NPI | 1215557913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 80340) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-04-04 |