| NPI | 1518990688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.064811) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: GA 065191) |
| 2085R0001X Radiology, Radiation Oncology (Licence: PA MD044867L) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2011-09-28 |