| NPI | 1114913290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: KY 33664) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: OH 68352) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-09-29 |