| NPI | 1245521905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 84047) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD457543) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2019-12-03 |