| NPI | 1720643844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A196987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 280180) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2024-09-05 |