| NPI | 1871045690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 75577-20) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA 153028) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2021-12-22 |