| NPI | 1194792630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 72955) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MA 72955) |
| 2085B0100X Radiology, Body Imaging (Licence: MA 72955) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2017-01-05 |