| NPI | 1255359766 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301059239) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 059239) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-01-02 |