| NPI | 1164488086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60178819) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 35386) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2013-04-23 |