| NPI | 1912956640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 13316) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: AZ 13316) |
| 2085P0229X Radiology Pediatric Radiology (Licence: AZ 13316) | |
| 2085R0203X Radiology Therapeutic Radiology (Licence: AZ 13316) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: AZ 13316) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2007-11-07 |