| NPI | 1588700744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX N3837) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A93857) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2012-07-23 |