| NPI | 1750309845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: OH 35.063750) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: TN 32175) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-08-01 |