| NPI | 1902873409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 54099) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MD D0041640) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2017-05-11 |