| NPI | 1578536397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.740361) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD062778L) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2021-07-14 |