| NPI | 1578502324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OK 19157) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 04 26140) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA G77074) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-03-12 |