| NPI | 1790165371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 73643-20) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301107779) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2021-03-18 |