| NPI | 1134651599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2024-00919) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: KY R5143) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2024-06-12 |