| NPI | 1205833480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD032609E) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: PA MD032609E) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD032609E) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2012-10-02 |