| NPI | 1790910412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX Q5028) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301094323) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2021-02-03 |