| NPI | 1912908419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD066001L) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: PA MD066001L) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-10-10 |