| NPI | 1750695201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 266608) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: CA A118605) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 279061) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2016-07-21 |