| NPI | 1548607278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.139922) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301104770) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2020-06-30 |