| NPI | 1699970525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301086290) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX N5580) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2019-01-17 |