| NPI | 1003102617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX Q8603) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A126086) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2016-08-16 |