| NPI | 1740464627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301100272) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: TN resident, no license) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2012-06-21 |