| NPI | 1851375505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: GA 39105) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 039105) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2016-02-15 |