| NPI | 1730382631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A105348) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090260) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2012-10-12 |