| NPI | 1730441544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CT 053417) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 53417) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2017-03-10 |