| NPI | 1477997914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MA 264896) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NH 18818) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2019-04-18 |