| NPI | 1972865731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX R2317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043084) |
| 207R00000X Internal Medicine (Licence: TX R2317) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2018-03-17 |