| NPI | 1215168109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2024022382) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 94-07228) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2024-07-22 |