| NPI | 1629085022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301077506) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WV 27699) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-12-08 |