| NPI | 1912963638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G76497) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA G76497) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA G76497) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2008-02-29 |