| NPI | 1235101825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ME MD18914) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD00048063) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2015-03-04 |