| NPI | 1548264120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: PA MD 040765 E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD-040765-E) |
| 2085R0203X Radiology Therapeutic Radiology (Licence: PA MD 040765 E) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2021-06-24 |