| NPI | 1326361585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A105271) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A105271) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2011-12-15 |