| NPI | 1760472823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: PA MD029390E) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: KY 43699) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2018-12-11 |