| NPI | 1285051540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: LA 313212) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NV 22208) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-06-28 |