| NPI | 1598715195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 33085) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MA 033085) |
| 2085N0700X Radiology Neuroradiology (Licence: MA 033085) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: MA 033085) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 033085) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: MA 033085) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-05-29 |