| NPI | 1093235673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: WI 77002) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.070719) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-09-15 |