| NPI | 1881745305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD00010969) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00010969) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2010-03-26 |