| NPI | 1629060256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ID M5310) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WY 12377C) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2019-10-24 |