| NPI | 1063641504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 254507) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: RI MD20328) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2025-01-07 |