| NPI | 1376520197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WV 11879) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY 15899) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2010-01-08 |