| NPI | 1164775334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OR MD187282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG162936) |
| 2085R0001X Radiology, Radiation Oncology (Licence: TX BP10048967) | |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2022-01-28 |