| NPI | 1689053100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 85336) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD469361) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2022-01-07 |