| NPI | 1134261902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ND 9833) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2010005862) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NV 16303) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2017-08-01 |