| NPI | 1639183940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: MO 2005023119) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2005023119) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2013-11-13 |