| NPI | 1154933034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CA A169906) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WA MD61171770) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2022-10-12 |