| NPI | 1174620504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CA 2085R0001X) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: TX Q2667) |
| 2085R0001X Radiology Radiation Oncology (Licence: OR MD182377) | |
| 2085R0001X Radiology Radiation Oncology (Licence: WA MD60457211) | |
| 2085R0001X Radiology Radiation Oncology (Licence: IA 37612) | |
| 208D00000X General Practice (Licence: CA G-38910) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-06-13 |