| NPI | 1962467738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: MO 2004026428) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2004026428) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-08 |