| NPI | 1376772574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301102359) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT195917) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2023-11-20 |