| NPI | 1104831833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 109698) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: MO 109698) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-04-29 |