| NPI | 1003899816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 58993) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 39768) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CO G53197) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2022-03-10 |