| NPI | 1578724878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: SC 30904) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL30904) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2020-10-08 |