| NPI | 1164409884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WV 19077) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY 30682) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2011-07-24 |