| NPI | 1679637946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TN 42003) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: GA 054850) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-11-10 |