| NPI | 1679957526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 71451-20) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A144541) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2020-08-10 |