| NPI | 1720378219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TN 57801) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NY 266171) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2022-03-24 |