| NPI | 1497716781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CA C193918) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: OK 19729) |
| 2085R0001X Radiology Radiation Oncology (Licence: CO DR0062949) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2025-08-11 |