| NPI | 1154770873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: FL ME164760) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: MA 287654) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-10-30 |