| NPI | 1114983871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301081806) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01059740A) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2021-01-22 |