| NPI | 1629070420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MN 53625) |
| Additional Taxonomies | 2085R0203X Radiology Therapeutic Radiology (Licence: IA 26861) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-10-04 |