| NPI | 1831509926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: OR MD192304) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WA 60954834) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT205798) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2020-07-08 |