| NPI | 1235121013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 119542) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MO 119542) |
| 2085B0100X Radiology, Body Imaging (Licence: MO MO0119542) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO MO0119542) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MO MO0119542) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2012-07-20 |