| NPI | 1992839773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: TX Q4092) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: KY 41258) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: OH 35.088922) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-09-11 |