| NPI | 1427252014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ND 11058) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 53647) |
| 2085R0001X Radiology, Radiation Oncology (Licence: TX M8324) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA A107158) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301095616) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-09-24 |