| NPI | 1184645525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD027335E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD027335E) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-04-13 |