| NPI | 1790908796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AL 29354) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NC 2007-01477) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-07-06 |