| NPI | 1407830375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME93478) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD434989) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NY 262266) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2015-06-29 |