| NPI | 1760863310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101269166) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 209917) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-06-22 |