| NPI | 1366823064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: GA 86243) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2015019301) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-01-07 |