| NPI | 1215943642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: LA 12437R) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 12437R) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2021-06-17 |