| NPI | 1013018159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200101032) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 200101032) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271324) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 85214) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-04-17 |