| NPI | 1982613386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 28453) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: NC 28453) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101051899) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2009-08-04 |