| NPI | 1891751046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 312777) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MA 154594) |
| 2085R0001X Radiology, Radiation Oncology (Licence: PA MD447072) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2022-01-10 |