| NPI | 1609223932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MT MED-PHYS-LIC-127559) |
| Additional Taxonomies | 2085R0001X (Licence: UT 11393127-1205) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2024-07-01 |