| NPI | 1811936693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A71969) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A71969) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-02-28 |