| NPI | 1215551965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NJ 25MA12489900) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT220867) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-07-07 |