| NPI | 1558521294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX P3455) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 103812) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MN 51288) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: WI 56311-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-03-29 |