| NPI | 1013126440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AZ 50323) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NY 247548) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301082079) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-04-21 |