| NPI | 1861887317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 007978) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ T40137090011872) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2016-04-18 |