| NPI | 1699271668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX U4661) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: UT 11420255-1205) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2023-08-21 |