| NPI | 1205892247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2004001436) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MO 2004001436) |
| 2085N0700X Radiology Neuroradiology (Licence: MO 2004001436) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: MO 2004001436) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: MO 2004001436) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2012-06-04 |