| NPI | 1457693079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: WI 68909-20) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: IL 036-146949) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2021-03-31 |