| NPI | 1568855161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 72314-20) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IL 036153609) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI R322630745086) | |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2020-09-28 |