| NPI | 1760484570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: SD 8285) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: IA 29580) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2013-12-20 |