| NPI | 1639163843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 32568) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: CO 32568) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO 32568) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CO 32568) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2009-03-12 |