| NPI | 1659514701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A130592) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: CA A130592) | |
| Enumeration Date | 2009-04-18 |
| Last Update Date | 2014-07-10 |