| NPI | 1700058021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OR MD172744) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 82131) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NH 15775) | |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2021-07-15 |