| NPI | 1013209550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD61604784) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.128451) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2024-12-11 |