| NPI | 1164674214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MD D80992) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA ML60040041) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2016-05-06 |