| NPI | 1508205311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 63501) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WI 5104-850) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2023-11-28 |