| NPI | 1922063197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101241386) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MD D62948) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2019-07-18 |