| NPI | 1780655027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 22223) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: AZ 22223) |
| 2085B0100X Radiology Body Imaging (Licence: AZ 22223) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2013-02-27 |