| NPI | 1285014035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX U4016) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301107668) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-08-17 |