| NPI | 1225456981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 71062-20) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2015013465) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-01-20 |