| NPI | 1831369289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101243355) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2008-00788) |
| 2085R0001X Radiology, Radiation Oncology (Licence: DC MD036388) | |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2021-03-09 |