| NPI | 1710997655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: AR E-1401) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: PA MD040642E) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2023-01-27 |