| NPI | 1609079151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101238679) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: LA MD.204262) |
| 2085R0001X Radiology, Radiation Oncology (Licence: FL ME103163) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2022-01-13 |