| NPI | 1598702375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NY 193492) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: NY 193492) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: NY 193492) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2009-05-11 |