| NPI | 1609896505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0904X Radiology, Nuclear Radiology (Licence: WY 2647A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 2647A) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WY 2647A) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: WY 2647A) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-09 |