| NPI | 1891761706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 33512) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: NC 33512) |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: NC 33512) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2014-05-08 |