| NPI | 1003166109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0052095) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX BP2-0035158) |
| Enumeration Date | 2012-09-16 |
| Last Update Date | 2022-05-18 |