| NPI | 1164161907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A191018) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT225725) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2024-12-20 |