| NPI | 1568725901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NJ 25MA11003200) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NY 283528) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-07-14 |