| NPI | 1700883485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL me0057091) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0057091) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL me0057091) | |
| 2085B0100X Radiology, Body Imaging (Licence: FL me0057091) | |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: FL me0057091) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: FL me0057091) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: FL me0057091) | |
| 2085N0700X Radiology, Neuroradiology (Licence: FL me0057091) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: FL me0057091) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-10-13 |