| NPI | 1770926701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101283484) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NY 294890-1) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2024-08-06 |