| NPI | 1811987449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: PA OS011978) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: PA BC2667763) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2025-03-31 |