| NPI | 1043417405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME112281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN11507) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2016-11-09 |