| NPI | 1689803579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 55365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 55365) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2018-08-02 |