| NPI | 1053356493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SC 32145) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101222866) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NC 2009-01685) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2012-12-18 |