| NPI | 1629205190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A93398) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MA L-239140) |
| 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101247041) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2017-02-22 |