| NPI | 1376598995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL OS8188) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 34006642) |
| 2085R0001X Radiology, Radiation Oncology (Licence: MS 28120) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-10-08 |