| NPI | 1396039426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: AZ 51715) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: PA MD457246) |
| 2085R0001X Radiology Radiation Oncology (Licence: CA 125615) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2020-09-08 |