| NPI | 1588630115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD032191E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD032191E) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2010-03-29 |