| NPI | 1518164862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X Radiology, Nuclear Radiology (Licence: TX P5355) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5355) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2019-04-30 |