| NPI | 1023001823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: KY 25049) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35054699) |
| 2085R0001X Radiology, Radiation Oncology (Licence: IN 01038729A) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2021-04-22 |