| NPI | 1811964059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239980) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 220615) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: MA 220615) | |
| 207U00000X Nuclear Medicine (Licence: VA 0101239980) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2012-11-02 |