| NPI | 1770541013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R1J52) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 43089-020) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: MO R1J52) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 22918) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-01-17 |