| NPI | 1720063076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MA 36483) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: MA 36483) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2020-11-17 |