| NPI | 1881705671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SC 30455) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200401182) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-10-18 |