| NPI | 1275565640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 034220) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: CT 034220) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CT 034220) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-06-17 |