| NPI | 1629572060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TX T5630) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T5630) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-08-15 |