| NPI | 1518979913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 13941288-1205) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: MA 228626) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 228626) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2024-05-23 |