| NPI | 1972659308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 005524) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: CA 20A9659) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A9659) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2019-01-23 |