| NPI | 1538249065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 043995) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CT 043995) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: CT 043995) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-06-17 |