| NPI | 1104812601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: PA MD038685L) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD038685L) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-06-21 |