| NPI | 1770841256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 296501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT201261) |
| 2085R0001X Radiology, Radiation Oncology (Licence: IN 01078147A) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2020-01-31 |