| NPI | 1992099956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MA 257398) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 247593) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MA 247593) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2016-07-14 |