| NPI | 1982696878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: OH 35.069956) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD062322L) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2017-01-01 |