| NPI | 1649562984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 55794) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 106184) |
| 2085R0001X Radiology, Radiation Oncology (Licence: WI 62333) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2024-05-23 |