| NPI | 1578564613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD038569Y) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY 43854) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2022-01-21 |