NPI | 1568721454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MO 2017011905) |
Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: KY R2917) |
Enumeration Date | 2012-05-11 |
Last Update Date | 2018-06-29 |