| NPI | 1770780686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TN 48652) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN11513) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2012-10-30 |