| NPI | 1063777647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: HI DOS-2028) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0102203567) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2021-06-09 |