| NPI | 1457586232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD451568) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD451568) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2019-09-27 |