| NPI | 1730506932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: KS 04-41941) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2019008077) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2019-08-22 |