| NPI | 1205062544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 260432) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240967) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: MA 240967) | |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2014-07-29 |