| NPI | 1578564241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX M3691) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 39212) |
| 174400000X Specialist | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-09-15 |