| NPI | 1255323663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MS 22217) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: TN 36779) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2018-03-30 |