| NPI | 1194833780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME154391) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD00040513) |
| 2085R0001X Radiology, Radiation Oncology (Licence: WI 1563-320) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-08-02 |