| NPI | 1063858769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: FL 173909) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: MN 63428) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2025-06-18 |