| NPI | 1679693147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: ND 11901) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KS 6699) |
| 207R00000X Internal Medicine (Licence: MI 4301087736) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2023-06-30 |