| NPI | 1528229788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 63928) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: SC MD 35286) |
| 2085R0001X Radiology, Radiation Oncology (Licence: OH 98883) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2013-08-09 |