| NPI | 1053722918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301117473) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206199) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2019-07-30 |