| NPI | 1639565948 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NJ 25MA11181200) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CT 64795) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2024-01-14 |