| NPI | 1689094930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101267395) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MT205778) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2019-12-30 |