| NPI | 1164531273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX L9252) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A73170) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-01-17 |