| NPI | 1477715407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: PA MD445249) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NJ 25MA09148500) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2013-07-31 |