| NPI | 1851360796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 63950-20) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 34883) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-03-11 |