| NPI | 1487674073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD024334E) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD024334e) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-07-14 |