| NPI | 1073801148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: IA 43526) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 55643) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MN 106355) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2020-11-10 |