| NPI | 1003812488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD072499L) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35060850L) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2021-12-27 |