| NPI | 1750591400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NH 17279) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MA 235496) |
| 2085R0001X Radiology, Radiation Oncology (Licence: VT 042.0013271) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2015-10-27 |