| NPI | 1972672392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301510548) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WI 49342-20) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2024-06-20 |