NPI | 1235584962 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301503774) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-05-02 |
Last Update Date | 2021-02-15 |