| NPI | 1679558811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA G77580) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G77580) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2022-04-05 |