| NPI | 1962812511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A168087) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101266281) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2020-06-02 |