| NPI | 1124251293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 264305) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA08646000) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NJ 25MA08646000) | |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2015-06-30 |