| NPI | 1366647737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A30909) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A30909) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2014-05-13 |