| NPI | 1811908064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: SC 30229) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35081789) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NC 200701182) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-12-18 |