| NPI | 1225039365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 83205) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IA 32028) |
| 2085R0001X Radiology, Radiation Oncology (Licence: WI 70913) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 22742) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2024-08-26 |