| NPI | 1225337462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX Q8087) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2013023000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2020-02-03 |