| NPI | 1801872262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101230493) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: VA 0101230493) |
| 207U00000X Nuclear Medicine (Licence: VA 0101230493) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2014-02-07 |