| NPI | 1255398764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301047912) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301047912) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2008-12-03 |