NPI | 1760514574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 67670) |
Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: GA 67670) |
2085N0700X Radiology Neuroradiology (Licence: GA 67670) | |
Enumeration Date | 2007-03-09 |
Last Update Date | 2013-04-17 |