| NPI | 1568770063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PR 19101) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 127851) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2016-02-10 |