| NPI | 1316959646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OR MD151974) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.135193) |
| 2085R0001X Radiology, Radiation Oncology (Licence: WY 12706C) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2022-02-22 |