| NPI | 1609131523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: FL ME127765) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: MI 261Q00000X) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2016-07-21 |