| NPI | 1497021158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ND 14656) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MN 56963) |
| 207R00000X Internal Medicine (Licence: MI 4301100541) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2024-04-04 |