| NPI | 1295723930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD055929L) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: PA MD055929L) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2013-02-20 |