| NPI | 1053816082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301508898) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 5315238655) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2023-08-07 |