| NPI | 1942294202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA 148885) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9100939) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116024991) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2020-04-20 |