| NPI | 1174528798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D0030426) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: WV 28596) |
| 2085R0001X Radiology Radiation Oncology (Licence: WV 28596) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2019-04-11 |