| NPI | 1710147814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: KY 51103) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY TP372) |
| 2085R0001X Radiology, Radiation Oncology (Licence: OH 35095286) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2022-06-22 |