| NPI | 1942294525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: PR 8651) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 8651) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 8651) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PR 8651) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2008-01-15 |