| NPI | 1851683684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A143472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199333) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199333) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2022-12-07 |