| NPI | 1861479156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 38977) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX N5595) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2022-06-01 |