| NPI | 1720155336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 104023) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301077272) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2022-09-01 |