| NPI | 1902820467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 86171) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NM A6-171) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: NM A6-171) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-06-06 |