| NPI | 1225080831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WY 5816A) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: CO DR.0061192) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-04-05 |