| NPI | 1871856641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 56878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2012018706) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MN 107113) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2018-06-25 |