| NPI | 1467899534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SC 52455) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301102835) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2018-06-11 |