| NPI | 1972965507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.142363) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: TX BP10061397) |
| 207R00000X Internal Medicine (Licence: KS 94-94-09015) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: TX S1961) | |
| 208D00000X General Practice (Licence: TX S1961) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2021-06-29 |