| NPI | 1255348512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2019029013) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AL 26070) |
| 2085R0001X Radiology, Radiation Oncology (Licence: GA 074739) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-04-06 |