| NPI | 1013085752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301052765) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: MI 4301052765) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-03-13 |