| NPI | 1851505408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60543038) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301084719) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-11-14 |