| NPI | 1619169935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TX N4828) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NY 230133) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2019-02-19 |