| NPI | 1982874582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TN MD0000043072) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN MD0000043072) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2023-01-04 |