| NPI | 1861874141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME146042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264332) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2020-07-06 |