| NPI | 1104441443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 8825) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NE 8825) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2021-06-01 |