| NPI | 1801887948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 60408) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 60408) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2010-06-04 |