| NPI | 1811964059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239980) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: VA 0101239980) |
| 2085N0904X (Licence: MA 220615) | |
| 2085B0100X Radiology, Body Imaging (Licence: MA 220615) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2025-12-29 |