| NPI | 1780677906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MS 13714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 13714) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2016-02-16 |