| NPI | 1386604346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 19772-020) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WI 19772-020) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: WI 19772-020) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 19772) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: WI 19772-020) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2019-01-08 |