| NPI | 1619147022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101248252) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NC 2009-00302) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-00302) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52532) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: MN 52532) | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2011-04-25 |