| NPI | 1659370419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9801350) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: NC 9801350) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 101053630) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22382) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2017-12-20 |