| NPI | 1699767939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA G87777) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 037130) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2016-03-22 |