| NPI | 1972797967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: KS 04-35824) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2015013772) |
| Enumeration Date | 2007-09-01 |
| Last Update Date | 2017-02-23 |