| NPI | 1194700625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: KY 43369) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: FL ME87407) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2013-12-12 |