| NPI | 1114997491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME105131) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301073591) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2017-11-08 |