| NPI | 1063803963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 75465) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IL 125.069817) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2021-08-11 |