| NPI | 1568721454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2017011905) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY R2917) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2018-06-29 |