| NPI | 1770566515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200000450) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NC 200000450) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2023-06-01 |