| NPI | 1750397071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60194923) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101239741) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-02-03 |