| NPI | 1659552792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 062145) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: GA 062145) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: GA 062145) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2009-08-07 |