| NPI | 1710362025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MS 947-L) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MS 947-L) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2019-01-29 |