| NPI | 1710270061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SD 11300) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WV 27066) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2019-01-30 |