| NPI | 1821594136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NM MD2023-1654) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY 53837) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-06-11 |