| NPI | 1801882527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 17932) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: SC 17932) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2010-06-21 |