| NPI | 1013900281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO CDRH.0040881) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 40881) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA C154753) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-10-11 |