| NPI | 1811105943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 54298) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX N7904) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA A104322) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-09-17 |