| NPI | 1770876070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2019010502) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: OK 29277) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2021-09-23 |