| NPI | 1659722353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0068692) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: SC 91470) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2024-02-06 |