| NPI | 1760829527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2021-02709) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NY 293549) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2022-01-03 |