| NPI | 1417913070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: GA 051336) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: GA 051336) |
| 2085B0100X Radiology, Body Imaging (Licence: GA 051336) | |
| 2085N0700X (Licence: GA 051336) | |
| 2085N0904X (Licence: GA 051336) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: GA 051336) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: GA 051336) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: GA 051336) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2013-10-31 |