| NPI | 1053673202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD 60482538) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA ML 60375662) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2015-07-22 |