| NPI | 1114959541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 029230) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: CT 029230) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: CT 029230) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-09-28 |