| NPI | 1215128491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX P4035) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301092367) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-12-10 |