| NPI | 1932133832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101232397) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: VA 0101232397) |
| 2085N0904X Radiology Nuclear Radiology (Licence: VA 0101232397) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0088043) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-03-07 |