| NPI | 1629060041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MS 16116) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 00019798) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2018-09-05 |