| NPI | 1376541649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.052348) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: WV 13934) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2021-02-12 |