| NPI | 1306869417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 240628) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME137717) |
| 208D00000X General Practice (Licence: FL ME137717) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-08-15 |