| NPI | 1720177819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60217830) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: SC ll27935) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-12-04 |