| NPI | 1558535971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: AK 128148) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WA MD60264794) |
| 2085R0001X Radiology Radiation Oncology (Licence: ID M-12402) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2020-12-01 |