| NPI | 1710114616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NV CL0236) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA 11414) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2023-02-27 |