| NPI | 1336174242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: AL 23329) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.125721) |
| 2085R0001X Radiology, Radiation Oncology (Licence: TN 40281) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: NC 2005-01653) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: MS 19096) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-12-01 |