| NPI | 1952693293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 55712) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 106342) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2020-08-18 |