| NPI | 1255523791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-00890) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NC 2009-00890) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 32465) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2020-09-29 |