| NPI | 1659633915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL TRN19256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043069) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2013-09-22 |