| NPI | 1861692436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO 0054755) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301090119) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090119) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2021-06-11 |