| NPI | 1497045058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: SC 29781) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: KY R2676) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2021-03-05 |