| NPI | 1679816920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: FL ME164834) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: KY 51400) |
| 2085R0001X Radiology Radiation Oncology (Licence: IN 01080042A) | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2024-02-06 |