| NPI | 1801058375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MD D73318) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101246387) |
| 2085R0001X Radiology, Radiation Oncology (Licence: PA MD442580) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2015-07-09 |