| NPI | 1417927625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301084977) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: VA 0101237067) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: MI 4301084977) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2016-02-15 |