| NPI | 1578806352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME163047) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301115745) |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2023-10-16 |