| NPI | 1003809005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI JF076329) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35-086184) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2017-01-05 |