| NPI | 1104915594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD026609L) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PA MD026609L) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-10 |