| NPI | 1679952915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX S3024) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R75045) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2020-06-02 |