| NPI | 1871868026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2017-00143) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: SC 40633) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2022-07-21 |