| NPI | 1255777561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2018010585) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: CT 54508) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2018-08-08 |