| NPI | 1003939133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA C171532) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.097376) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-05-13 |