| NPI | 1396709721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX M5415) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: LA MD 200042) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2021-06-16 |