| NPI | 1700804317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101045836) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: VA 0101045836) |
| 2085N0700X Radiology Neuroradiology (Licence: VA 0101045836) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: VA 0101045836) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: VA 0101045836) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: VA 0101045836) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: VA 0101045836) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2010-12-01 |