| NPI | 1477715811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101259647) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD13443) |
| 207U00000X Nuclear Medicine (Licence: RI MD13443) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2018-01-16 |