| NPI | 1619163649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 43282) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD61259560) |
| 2085R0001X Radiology, Radiation Oncology (Licence: UT 6359017-1205) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2022-03-18 |