| NPI | 1609816214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WV 24688) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101237252) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2013-09-12 |