| NPI | 1639279763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CO 27422) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WI 82619) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-09-23 |