| NPI | 1679035505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: UT 11885666-1205) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: ID M17713) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-05-18 |