| NPI | 1962886093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: WV 30748) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: PA MT208021) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2021-12-14 |