| NPI | 1396970562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60551342) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: WA MD60551342) |
| 207U00000X Nuclear Medicine (Licence: CO DR.0055346) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD172582) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0055346) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2018-06-29 |