| NPI | 1316205628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-00628) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 2019-00628) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: NC 2019-00628) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2020-09-25 |