| NPI | 1790077584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD479870) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 61803) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2023-03-22 |