| NPI | 1831325919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: SC 36715) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: SC TL36715) |
| 207R00000X Internal Medicine (Licence: NC 157108) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2023-05-31 |