| NPI | 1538177514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0049535) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WY 8899A) |
| 2085R0001X Radiology, Radiation Oncology (Licence: TX Q0444) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2019-01-02 |