| NPI | 1518265420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2011-00515) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: SC 33384) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2012-12-19 |