| NPI | 1699384024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: TX V5338) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN31441) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2025-04-25 |