| NPI | 1225071616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 056409) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 056409) |
| 2085N0700X Radiology, Neuroradiology (Licence: GA 056409) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: GA 056409) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-07-23 |