| NPI | 1063492957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 47136) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 46987) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2015-07-30 |