| NPI | 1922217793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: MI 4301087547) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.095331) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-03-05 |