| NPI | 1114201514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MN 60519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57019755) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2023-03-28 |