| NPI | 1295016004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MN 70338) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.134635) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2021-10-18 |