| NPI | 1568671113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: MI 4301081853) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: OH 35-091603) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2023-11-03 |