| NPI | 1023245115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA R-8862) |
| Additional Taxonomies | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: IA MD42022) |
| 2085B0100X Radiology Body Imaging (Licence: IA MD42022) | |
| 2085H0002X Radiology Hospice and Palliative Medicine (Licence: IA MD42022) | |
| 2085N0700X Radiology Neuroradiology (Licence: IA MD42022) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: IA MD42022) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: IA MD42022) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: IA MD42022) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2025-05-02 |