| NPI | 1982099412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: ID 15172) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WA 61047154) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2020-07-01 |