| NPI | 1790005197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: AZ 006651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R1783) |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2020-01-08 |