| NPI | 1578711164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 51141) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 103750) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2008-12-26 |