| NPI | 1982642138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 12065) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: NE 12065) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NE 12065) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2008-06-04 |