| NPI | 1518969021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60299819) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 14068) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-03-07 |