| NPI | 1730172362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GU M-1793) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101046565) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2024-12-23 |