| NPI | 1811330731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 79946) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CO TL.0004645) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2021-03-15 |