| NPI | 1780682880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MO R7765) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: KS 04-24721) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2019-11-08 |