| NPI | 1275580961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: UT 4811024-1205) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: MA 77358) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2021-11-08 |