| NPI | 1073824553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2015023179) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 9407527) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2015-12-16 |