| NPI | 1194961789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: UT 8680275-1205) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 52159) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MN 104512) | |
| Enumeration Date | 2009-01-02 |
| Last Update Date | 2021-09-06 |