| NPI | 1720061534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301082448) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA A85446) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2016-02-08 |