| NPI | 1386648988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: KY 38847) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: IN 01070211A) |
| 2085R0001X Radiology, Radiation Oncology (Licence: OH 35097980) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2022-09-22 |