| NPI | 1376565374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: CA A99453) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: AZ 35670) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2012-10-03 |