| NPI | 1811974199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2008030172) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 04-33167) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2015-04-21 |