| NPI | 1902149636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 081176) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME164069) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-09-08 |