| NPI | 1972507655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 20965) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 20965) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: NC 20965) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 20965) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-04-26 |