| NPI | 1720191083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 9737) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: SC 9737) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: SC 9737) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2008-07-25 |