| NPI | 1922090315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MO 36469) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.056720) |
| 2085R0001X Radiology, Radiation Oncology (Licence: AR E7178) | |
| 2085R0001X Radiology, Radiation Oncology (Licence: KS 0431774) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: TX H4893) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2023-08-29 |