| NPI | 1457364861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: NY 479839) |
| Additional Taxonomies | 2471R0002X Radiologic Technologist, Radiation Therapy (Licence: NJ 636578) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |