| NPI | 1295182442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VT 042-0016454) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NY 308237-01) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2023-12-23 |