| NPI | 1912571654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 2022017916) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125077834) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2022-08-22 |