| NPI | 1093864480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 5101020311) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NE 429) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2022-11-27 |