| NPI | 1356412050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA A96202) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A96202) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2018-06-04 |