| NPI | 1639706450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T8887) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX In-Training) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2022-08-05 |