| NPI | 1053415364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2006-00792) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: VA 0101237007) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ND 16842) | |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2022-02-04 |