| NPI | 1215377056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 256110) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NY 276550) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2014-08-04 |