| NPI | 1871552638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME40682) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AL MD.11479) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2024-12-02 |