| NPI | 1902888126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: UT 7692036-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5161) |
| 2085R0001X Radiology, Radiation Oncology (Licence: NJ 25MA08194700) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2021-11-12 |