| NPI | 1700882685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301070393) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35080933) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2021-04-15 |