| NPI | 1790719318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AL MD.29203) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WI 1760) |
| 174400000X Specialist (Licence: AL 29203) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: FL ME 106420) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-01-28 |