| NPI | 1487638607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 042424) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 042424) |
| 2085R0001X Radiology, Radiation Oncology (Licence: AL MD.19982) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2023-12-14 |