| NPI | 1063076719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SD 15566) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 77681) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2024-09-05 |