| NPI | 1851628077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60597209) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: ID M-13076) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2017-03-24 |