| NPI | 1518353887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A147657) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A147657) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-01-21 |