| NPI | 1679508352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME120553) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD467778) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-10-01 |