| NPI | 1952729964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: NJ 25MA11182000) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: PA MD475020) |
| 2085R0001X Radiology Radiation Oncology (Licence: GA 83184) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2021-09-08 |