| NPI | 1356565261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME103723) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301084017) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2014-10-09 |