| NPI | 1669774386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0058426) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 052361) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2019-12-11 |