| NPI | 1124482666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME160808) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WV 30579) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-10-18 |