| NPI | 1790040178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NJ 26MA09256400) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: GA 074079) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2023-07-17 |