| NPI | 1336359876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX M9737) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 71803) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-06-19 |