| NPI | 1811100746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: WA MD60158589) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 090253) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2014-09-08 |