| NPI | 1972572329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: MA 220223) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: MA 220223) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: MA 220223) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2007-07-08 |