| NPI | 1578576526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 41876) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 429305) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301075124) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: NC 0098-01682) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |