| NPI | 1194706275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WV 24090) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO R5409) |
| 174400000X Specialist (Licence: WV 24090) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2010-10-25 |