| NPI | 1538571062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME141004) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IA R-10196) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2019-08-20 |