| NPI | 1538540117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME144760) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301107971) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2021-10-29 |