| NPI | 1023351822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A152661) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX BP10049243) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2020-11-13 |