| NPI | 1699777854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO 47586) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 17812) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2016-11-30 |