| NPI | 1578608899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NV 11656) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301031205) |
| 2085R0001X Radiology, Radiation Oncology (Licence: AL MD.27708) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-07-11 |