| NPI | 1528509767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 68868) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: UT 11420213-1205) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-06-20 |