| NPI | 1811284375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2016014780) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301099423) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2016-06-02 |