| NPI | 1780894634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 55394) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TN 390200000X) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-19 |