| NPI | 1568882900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: CT 69866) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NJ 25MA10628000) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2021-12-09 |