| NPI | 1154612109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 072597) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 56516) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2022-04-12 |