| NPI | 1790195188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A137746) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: FL 119864) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2015-08-24 |