| NPI | 1477703031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME120514) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NM MD2010-0154) |
| 2085R0001X Radiology, Radiation Oncology (Licence: TX N6080) | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2014-09-17 |