| 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 |