| NPI | 1487696456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD018280E) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: PA MD018280E) |
| 2085N0700X Radiology Neuroradiology (Licence: PA MD018280E) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: PA MD018280E) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-01-07 |