| NPI | 1780668400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NJ 25MA09380900) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: NY 196138) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2024-06-03 |