| NPI | 1104969740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD446756) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101048801) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2015-09-17 |