| NPI | 1104896794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME167833) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A87177) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NV 13433) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60622589) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-05-23 |