| NPI | 1003800400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35080764) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY 37338) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2021-04-22 |