| NPI | 1811976673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 9801145) |
| Additional Taxonomies | 207UN0902X Nuclear Medicine Nuclear Imaging & Therapy (Licence: NC 9801145) |
| 207Q00000X Family Medicine (Licence: NC 9801145) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2011-02-16 |