| NPI | 1790754158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NC 27704) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: SC 14115) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2015-07-29 |