| NPI | 1497118806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AL MD.42786) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AL 42786) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2024-02-01 |