| NPI | 1811915515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ND 3943) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 26107) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-12-29 |