| NPI | 1316044316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA G44161) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 62298) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NC 2011-01713) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-01-23 |