| NPI | 1902001803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX N9841) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NY 60-244678) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-01-11 |