| NPI | 1073604559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-8495) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA MD.201128) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2014-05-22 |