| NPI | 1942761812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: CA A191064) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-12-17 |