| NPI | 1720512296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 295082) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA 60737288) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-03-26 |