| NPI | 1720159247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QX0203X Clinic/Center, Oncology, Radiation (Licence: FL ME78916) |
| Additional Taxonomies | 261QX0203X Clinic/Center, Oncology, Radiation (Licence: PR 014754) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-07-01 |