| NPI | 1811200736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 50233) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX Q3105) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MN 54601) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2020-09-08 |