| NPI | 1366599631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD61157599) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NV 9893) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2022-04-22 |