| NPI | 1417969064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: KY 34198) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD-067177-L) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2013-06-11 |