| NPI | 1447255641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 23023) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 24275) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-08-05 |