| NPI | 1013997782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 114884) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: MO 114884) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: MO 114884) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2023-08-10 |