| NPI | 1710362652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 276275) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: MA 262826) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2018-09-06 |