| NPI | 1336135516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO 46201) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 34036) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-03-30 |