| NPI | 1639164585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 4221) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: PR 4221) |
| 2085N0700X Radiology, Neuroradiology (Licence: PR 4221) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2010-03-25 |