| NPI | 1376753889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MS 20557) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: AL 26887) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2009-11-10 |