NPI | 1811312812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA OP61097078) |
Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0102204232) |
Enumeration Date | 2014-02-27 |
Last Update Date | 2022-02-04 |