| NPI | 1699709139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: RI MD13152) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35-073919) |
| 2085R0001X Radiology, Radiation Oncology (Licence: FL 159050) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: MA 39665) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-01-16 |