| NPI | 1811230600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: OH 35-127563) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WA 60341979) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2024-09-04 |