| NPI | 1568457257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SD 4542) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WI 31368) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2012-09-27 |