| NPI | 1821331596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0069161) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2018013502) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2022-08-03 |