| NPI | 1649470311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2016034947) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 37277) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2016-10-11 |