| NPI | 1801894761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX R5519) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME59489) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2018-06-04 |