| NPI | 1407116163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX R3455) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN17315) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2019-06-20 |