| NPI | 1790066090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CA A117696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A117696) |
| 2085R0203X Radiology Therapeutic Radiology (Licence: CA A117696) | |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2018-03-17 |