| NPI | 1811981087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 15587) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NC 15587) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2010-01-20 |