| NPI | 1346477205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WI 54811-020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 54811-020) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2020-08-07 |