| NPI | 1790805968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MD D0069026) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MA 223280) |
| 2085R0001X Radiology, Radiation Oncology (Licence: RI MD13055) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-12-22 |