| NPI | 1477819670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD461776) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NC 190880) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2017-09-01 |