| NPI | 1245296904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME63023) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI AA060744) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2018-03-17 |