| NPI | 1134418890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0057119) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA ML 60285285) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2016-08-01 |