| NPI | 1063648947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60470849) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OR LL18727) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2021-10-13 |