| NPI | 1851824650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301510476) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX T4272) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2024-03-13 |