| NPI | 1952455768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SC 37316) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NC 9501034) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-06-14 |