| NPI | 1023227824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX P2330) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301086176) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2021-01-06 |