| NPI | 1306280573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CO DR.0069430) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 63400) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2022-08-25 |