| NPI | 1912982802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME59298) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL FLME59298) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2016-10-20 |