| NPI | 1639175565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35046817) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301057202) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2012-08-31 |