| NPI | 1194136713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 59442) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 62580) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2021-09-29 |