| NPI | 1376593020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: UT 8309974-1205) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WI 49958) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-08-12 |