| NPI | 1811158587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: IA 40488) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: VA 0101254456) |
| 208D00000X General Practice (Licence: IA 40488) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: MS 22260) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2019-09-18 |