| NPI | 1255565842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301109294) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MI 4301109294) |
| 2085N0700X (Licence: MI 4301109294) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 257877) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2019-08-09 |