| NPI | 1174506489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME0053948) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: AL 18460) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2015-05-04 |