| NPI | 1720230063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX N9966) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301104721) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2017-12-15 |