| NPI | 1407948805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 54475-20) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301074664) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2019-12-16 |