| NPI | 1023099249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NH EL01002) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MA 75326) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NH 22287) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: VT 042.0015677) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: MA 75326) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2022-03-21 |