| NPI | 1215962287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX L7985) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L7985) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-02-13 |