| NPI | 1902124936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NE 28713) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0001X Radiology, Radiation Oncology (Licence: FL ME115171) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2016-02-11 |