| NPI | 1871988261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD483282) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0001X Radiology, Radiation Oncology (Licence: MD D89794) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2024-05-08 |