| NPI | 1801875919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2011003924) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 0422332) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2015-04-16 |