| NPI | 1740493774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CA C188890) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 57.004909) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-11-14 |