| NPI | 1689658304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 195589) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 56678) |
| 2085R0001X Radiology, Radiation Oncology (Licence: GA 075671) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2022-07-21 |