| NPI | 1669944237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MI 4301505747) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NY 293471) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2021-12-02 |