| NPI | 1164488573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX N0308) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: LA MD13721R) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA G68759) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: TN 28335) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-04-01 |