| NPI | 1811524556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: AL 51023) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: FL ME162153) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-07-18 |