| NPI | 1205831922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA C51244) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO R4B37) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2022-01-17 |