| NPI | 1205162922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MT 20621) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A100507) |
| 2085R0001X Radiology, Radiation Oncology (Licence: IA 40589) | |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2013-08-06 |