| NPI | 1477083301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NC 2022-01555) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: VA 0101275245) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-05-09 |