| NPI | 1124068275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TN 39315) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WY 14416C) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2025-05-28 |