| NPI | 1861475535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 051263) |
| Additional Taxonomies | 2085R0204X Radiology Vascular & Interventional Radiology (Licence: GA 051263) |
| 2085N0700X Radiology Neuroradiology (Licence: GA 051265) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: GA 051265) | |
| 2085N0904X Radiology Nuclear Radiology (Licence: GA 051265) | |
| Enumeration Date | 2005-11-27 |
| Last Update Date | 2007-07-08 |