| NPI | 1497044085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301098828) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.129442) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2020-02-05 |