| NPI | 1417117094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WV 25435) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IN 11014451A) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2014-05-07 |