| NPI | 1962606533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TX M6643) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: TX BP1-0022215) |
| 2085R0203X Radiology Therapeutic Radiology (Licence: TX M6643) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-11-06 |