| NPI | 1376527531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: GA 46327) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 046327) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2015-10-01 |