| NPI | 1174639736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 245223) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA OP00001834) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-10-06 |