| NPI | 1295052264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PR 21331) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2014-02489) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2021-05-19 |