| NPI | 1508880337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME105971) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD00025438) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2012-11-29 |