| NPI | 1669421012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CA G34416) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WV 25351) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2020-06-18 |