| NPI | 1588695969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SC 14387) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 14387) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-10-01 |