| NPI | 1861619173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CO 25084) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: CO DR0025084) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-06-11 |