| NPI | 1629177936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: LA 202753) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD00038248) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2011-12-28 |