| NPI | 1811337546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME134889) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IL 125.062606) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2018-08-02 |