| NPI | 1417310046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: UT 12250382-1205) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WY 13723A) |
| 2085R0001X Radiology Radiation Oncology (Licence: ID M-15792) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-02-16 |