| NPI | 1770589707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A46608) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A46608) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2023-08-16 |