NPI | 1629076310 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD017446E) |
Additional Taxonomies | 174400000X Specialist (Licence: PA MD017446E) |
2085U0001X Radiology Diagnostic Ultrasound (Licence: PA MD017446E) | |
Enumeration Date | 2005-07-07 |
Last Update Date | 2008-05-29 |