| NPI | 1972510493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: FL ME96366) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35099044) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-06-13 |