| NPI | 1053966465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301501156) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME143789) |
| 2085R0001X Radiology, Radiation Oncology (Licence: CA A167946) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: NY 302567) | |
| Enumeration Date | 2019-08-04 |
| Last Update Date | 2023-11-13 |