| NPI | 1649632019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NE 33763) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IA MD-48761) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2021-07-26 |