| NPI | 1821067430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TN MD0000030486) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: GA 045596) |
| 2085R0001X Radiology Radiation Oncology (Licence: AL 00025325) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |