| NPI | 1194955666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T6706) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: FL ME139056) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301094114) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2023-07-11 |