| NPI | 1124256557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: PA MT197482) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL31966) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2018-04-12 |