| NPI | 1689899676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX Q2340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 001964) |
| 2085R0001X Radiology, Radiation Oncology (Licence: IN 01078263A) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-11-20 |