| NPI | 1134485766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OR MD197158) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD61022150) |
| 2085R0001X Radiology, Radiation Oncology (Licence: GA 077772) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2020-12-14 |